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American Journal of Ophthalmology [journal]
- Pentacam Scheimpflug tomography findings in topographically-normal patients and subclinical keratoconus cases. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Apr 4.
To evaluate Pentacam ectasia detection indices in topographically-normal patients and in subclinical keratoconus cases.Prospective, observational case series.Setting: institutional; Patients: group 1 comprised one eye from 189 patients with unremarkable topography and groups 2 and 3 included the better and worse eyes, respectively, of 55 keratoconic patients. Group 2 eyes with normal topography (n=37) were considered subclinical keratoconus cases; Observation procedure: Pentacam Scheimpflug tomography; Main outcome measurements: 11 Pentacam ectasia detection indices.All Pentacam ectasia indices significantly differed between groups 1 and 2 and were correlated with keratoconus grade. Only 99 (52%) eyes in group 1 had normal values for every index, whereas 7 (19%) subclinical keratoconus eyes showed 2 or less abnormal indices. Standardized relational thickness and overall deviation indices had 73% and 89% sensitivity for subclinical keratoconus, respectively. Both average and maximum pachymetric progression indices offered 84% sensitivity while maximum relational thickness index showed 78% sensitivity for subclinical keratoconus. Optimized cutoff values for subclinical keratoconus increased the sensitivity of the standardized and maximum relational thickness indices.Pentacam Scheimpflug tomography can detect most subclinical keratoconus cases with unremarkable topography but performance is not as good as reported and varies considerably for each index. The overall deviation, average and maximum pachymetric progression and maximum relational thickness indices offer the highest sensitivity, which can be improved by using optimized cutoff values. Specificity constitutes an issue for some indices and up to 10% of subclinical keratoconus cases may go undetected by this technology.
- Patterns of Peripheral Retinal and Central Macula Ischemia in Diabetic Retinopathy as evaluated by Ultra Widefield Fluorescein Angiography. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Apr 4.
To investigate the association between peripheral and central ischemia in diabetic retinopathy.Retrospective, cross-sectional METHODS: Consecutive ultra widefield fluorescein angiography images were collected from patients with diabetes over a 12-month period. Parameters quantified include the foveal avascular zone (FAZ) area, peripheral ischemic index, peripheral leakage index, and central retinal thickness measurements, and visual acuity. The peripheral ischemia or leakage index was calculated as the area of capillary non perfusion or leakage, expressed as a percentage of the total retinal area.47 eyes of 47 patients were included. A moderate correlation was observed between the peripheral ischemia index and FAZ area (r=0.49, p=0.0001). A moderate correlation was also observed between the peripheral leakage index and FAZ area, but only in eyes that were laser naive (r=0.44, p=0.02). A thinner retina was observed in eyes with macular ischemia (217 ± 81.8μm versus 272 ± 36.0μm) (p=0.02), but not peripheral ischemia (258 ± 76.3μm versus 276 ± 68.0μm) (p=0.24). The relationships between different patterns of peripheral and central macular pathology and visual acuity were evaluated in a step-wise multivariable regression model, and the variables that remained independently associated were, age (r=0.33, p=0.03), FAZ area (r=0.45, p=0.02), and central retinal thickness (r=0.38, p=0.01), (R(2)-adjusted=0.36).Ultra widefield fluorescein angiography provides an insight into the relationships between diabetic vascular complications in the retinal periphery and central macula. Although we observed relationships between ischemia and vascular leakage in the macula and periphery, it was only macular ischemia and retinal thinning that was independently associated with a reduced visual function.
- Lamellar Keratoplasty Following Thermokeratoplasty in the Treatment of Acute Corneal Hydrops. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Mar 31.
To observe the efficacy of deep anterior lamellar keratoplasty (DALK) for treatment of acute hydrops in keratoconus after anterior chamber paracentesis combined with thermokeratoplasty.Retrospective, noncomparative clinical case series.Twenty-one patients (21 eyes) suffering acute hydrops associated with keratoconus were treated first by anterior chamber paracentesis combined with thermokeratoplasty. At 1 week after the edema was absorbed, and Descemet membrane ruptures and stromal clefts were cured, all patients received modified DALK. Descemet membrane re-ruptures during surgery were recorded if any. Graft transparency, visual acuity, recipient folds or opacity, and immune rejection were monitored for 6 months to 1 year.All the corneal edema alleviated rapidly, and the intra-stromal clefts narrowed within 1 week after combined anterior chamber paracentesis and thermokeratoplasty. DALK was performed successfully in all patients within 2 weeks after the first surgical procedure, with no Descemet membrane re-breaking or corneal perforation. The recipients were completely clear in 7 eyes, and mild fusiform scars appeared at the central recipient in 14 eyes. All the opacity of Descemet membrane ruptures became slight and even disappeared after 6 months. The mean best corrected visual acuity was improved to 20/30 at 1 year after DALK. No immune rejection occurred.Anterior chamber paracentesis combined with thermokeratoplasty can accelerate the absorption of corneal edema in patients with acute corneal hydrops (within 1 week) and Descemet membrane rupture healing without obvious opacity (within 2 weeks). During this window phase, DALK could be performed safely, and good visual acuity may be obtained.
- The Evolution of Laser Therapy in Ophthalmology: A Perspective on the Interactions between Photons, Patients, Physicians and Physicists The LXX Edward Jackson Memorial Lecture. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Mar 31.
To present the evolution of laser therapy in modern ophthalmic practice DESIGN: Review of published experimental and clinical studies METHODS: A review of the work of multiple investigators leading to the invention of the laser, its biophysical effects on ocular tissues from which it derives it name ( light amplified stimulation of emitted radiation) , and the development of various laser based devices and methods to treat common ophthalmologic disorders with particular emphasis on new and emerging retinal and anterior segment applications.Because the eye is optimized for the transmission of light and its transduction into neural signals, lasers are particularly well suited for ophthalmic therapy. This fact and the high demands for precision in therapy have inspired the development of highly sophisticated laser systems that have impacted the treatment of common diseases. These include diabetic retinopathy, age related macular degeneration, retinal venous occlusive disease, retinopathy of prematurity, optical aberrations including ametropia, cataract and glaucoma amongst others. Recent developments in scanning laser systems, including image guided systems with eye tracking, real-time feedback, as well as ultra-short pulse durations have enabled increased selectivity, precision and safety in ocular therapy. However, improved outcomes have been associated with increased cost of medical care, and attention to and optimization of their cost effectiveness will continue to be required in the future.The invention and evolution of modern ophthalmic lasers have enhanced therapeutic options and can serve as a heuristic model for better understanding the process of innovation, including the societal benefits and also unintended consequences including increased costs.
- Prosthetic Replacement of the Ocular Surface Ecosystem Scleral Lens Therapy for Patients with Ocular Symptoms of Chronic Stevens-Johnson Syndrome. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Mar 31.
To evaluate the results of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral lens treatment on visual acuity and function in patients with ocular symptoms of chronic Stevens-Johnson syndrome (SJS).Retrospective interventional case series.Single multi-specialty institutional practice Study population: A chart review from July 2009 to July 2013 identified 19 patients with ocular symptoms from chronic SJS who were referred PROSE fitting evaluation. Three patients deemed appropriate candidates were excluded because they were lost to follow up during the fitting process. Only 1 eye was fitted in 4 patients because anatomic changes prohibited PROSE fitting in the fellow eye. Another patient chose to have PROSE fitting only in 1 eye.A total 27 eyes of 16 patients who completed PROSE fitting were included in this study.PROSE scleral lens fitting. Outcomes Measures: Visual acuity and visual function were assessed before and after PROSE fitting using Snellen acuity and Ocular Surface Disease Index (OSDI) survey. The OSDI survey is a validated questionnaire that assess ocular surface disease in the context of vision-related function, ocular symptoms and environmental triggers.Visual acuity improved from 0.43 ± 0.35 logMAR pre-PROSE to 0.14 ± 0.22 logMAR post-PROSE (p = 0.0007) in SJS patients. OSDI scores improved from 70.4 ± 19.0 pre-PROSE to 37.4 ± 23.2 post-PROSE (p = 0.0002) in the same cohort.The results of this study show that PROSE treatment is a viable option for improving visual acuity and function in SJS patients who failed conventional treatment.
- Factors Influencing Long-term Regression after Posterior Chamber Phakic Intraocular Lens Implantation for Moderate to High Myopia. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Mar 31.
To evaluate the factors affecting the long-term regression after posterior chamber phakic intraocular lens (Visian ICL(TM), STAAR Surgical) implantation for myopia.Retrospective observational case series.We retrospectively examined 60 eyes of 35 consecutive patients (age, 38.4 ± 9.3 years (mean ± standard deviation)) with myopic refractive errors of -4.00 to -15.25 diopters (D) undergoing ICL implantation. We assessed the amount of myopic regression from 1 month to 6 years after surgery. Stepwise multiple regression analysis was used to assess the factors affecting the amount of myopic regression.The mean myopic regression from 1 month to 6 years after surgery was -0.33 ± 0.71 D (0.75 to -3.00 D). Explanatory variables relevant to the myopic regression were, in order of influence, the patient age (partial regression coefficient B=-0.042, p<0.0001), and the preoperative axial length (B=-0.186, p=0.013)(adjusted R2=0.300). No significant correlation was seen with other clinical factors such as gender, preoperative refraction, intraocular pressure, white-to-white distance, anterior chamber depth, central corneal thickness, or mean keratometric readings.Although the great majority of the variance remains unexplained, eyes of older patients' eyes and longer axial length are more predisposed to show greater myopic regression after ICL implantation. These results indicate that not only patient age but also axial length may play some role in predicting the long-term refractive outcomes of this surgical procedure.
- Comparison of Ocular Surface Disease Index and Tear Osmolarity as Markers of Ocular Surface Dysfunction in Video Terminal Display Workers. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Mar 13.
To compare the ocular surface disease index (OSDI) questionnaire and tear osmolarity, to screen ocular surface alterations in video display terminal (VDT) users.Cross-sectional study.Sixty-four VDT workers were screened for ocular surface alterations using OSDI and tear osmolarity. Furthermore, tear film break-up time (TBUT), fluorescein corneal stain and assessment for meibomian glands dysfunction (MGD) were carried out. The alteration of two or more among these parameters was considered a sign of ocular surface dysfunction. Data for the statistical analysis were obtained from the eyes with the worst tear osmolarity score. Main outcome measures were: OSDI and tear osmolarity. For the statistical analysis the receiver operating characteristic (ROC) curves and Spearman's correlation coefficient were used. A p<0.05 was considered statistically significant.The area under the ROC curve (AUC) for tear osmolarity (ranging from 0.71 to 0.86) showed, for all the classification variables considered, statistically significantly higher values than those obtained with OSDI (ranging from 0.51 to 0.58) (p<0.01). Furthermore, tear osmolarity showed a direct correlation with corneal stain and ocular surface dysfunction and an inverse correlation for TBUT. No correlation was found between OSDI and the parameters considered.Tear osmolarity can be considered a more reliable test than OSDI, when screening VDT users for possible ocular surface alterations.
- Selective Serotonin Reuptake Inhibitor Use and Increased Risk of Cataract Surgery: A Population-Based, Case-Control Study. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Mar 13.
To investigate whether selective serotonin reuptake inhibitor use is associated with an increased risk of cataract surgery.Population-based, case-control study METHODS: Setting: Olmsted County, Minnesota. Patient Population: Eligible patients were county residents in the Rochester Epidemiology Project. Cases included 6,024 county residents aged 50+ years who underwent first-eye cataract surgery between January 1, 2004 and December 31, 2011. Controls included 6,024 residents who never had cataract surgery and were matched to cases by age, sex, and date of surgery. Logistic regression models were used to compute odds ratios for differences in selective serotonin reuptake inhibitor use between cases and controls, and to adjust for confounding variables. Observation Procedure: Rochester Epidemiology Project databases were used to assess cataract surgery and selective serotonin reuptake inhibitor treatment. Main Outcome Measure: Selective serotonin reuptake inhibitor use.In the cataract surgery cohort of 6,024 residents, 1,024 (17%) were selective serotonin reuptake inhibitor users compared to 788 (13%) in the matched cohort of 6,024 residents never having cataract surgery (P<0.001). Selective serotonin reuptake inhibitor use of 1 or more years was associated with an increased risk of cataract surgery (OR=1.36; 95% CI, 1.23 - 1.51; P<0.001). The associations were similar in women (OR=1.37; 95% CI, 1.22-1.55; P<0.001) and men (OR=1.34; 95% CI, 1.12-1.61; P=0.002). The risk of cataract surgery was highest with citalopram use (OR=1.53, 95% CI, 1.33-1.77; P<0.001).Selective serotonin reuptake inhibitor use of 1 or more years in people aged 50+ years is associated with an increased risk of cataract surgery.
- Ghost Maculopathy: An Artifact on Near-Infrared Reflectance and MultiColor™ Imaging Masquerading as Chorioretinal Pathology. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Mar 11.
To describe the features of an artifact on near-infrared reflectance and MultiColor™ imaging termed as 'ghost maculopathy' and to illustrate how it may masquerade as true chorioretinal pathology.This was a retrospective, observational case series.We studied 144 eyes of 72 consecutive patients in a vitreoretinal clinical practice, reviewing multimodal imaging including color and red-free fundus photography, fundus autofluorescence (FAF), near-infrared reflectance, MultiColor™ imaging and spectral-domain optical coherence tomography (SD-OCT).In 36 of 144 (25%) eyes, there was an appearance of a hyper-reflective spot on near-infrared reflectance and MultiColor™ imaging, located at the macula, nasal or superonasal to the fovea, which did not correspond to any apparent lesion on color and red-free fundus photography, FAF or SD-OCT. This spot was termed the 'ghost image' in this phenomenon of 'ghost maculopathy'. The ghost image was present consistently on near-infrared reflectance and MultiColor™ imaging in all 36 eyes at every imaging encounter, showed minimal and subtle variability in its shape and location within each eye, however, showed large inter-individual variability in size, shape, location and reflectivity between different eyes. Nine eyes were found to have a similar hyper-reflective spot resembling that in ghost maculopathy but corresponding SD-OCT images were consistent with diagnoses of choroidal nevus, age-related macular degeneration and multifocal choroiditis. All eyes with ghost maculopathy were found to be pseudophakic with a posterior chamber intraocular lens.Ghost maculopathy is the phenomenon of an imaging artifact appearing at the macula on near-infrared reflectance and MultiColor™ imaging that occurs predominantly in pseudophakic patients and may be mistaken for true chorioretinal pathology. Awareness of this artifact is prudent to avoid misinterpretation of clinical findings and possible unnecessary over-investigations.
- New Testing Options for Diagnosing and Grading Dry Eye Disease. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Mar 11.
To describe new options for diagnosis and severity grading of dry eye disease DESIGN: Perspective on technological advancements to identify tear dysfunction and their value in diagnosing and grading dry eye disease.Evidence is presented on new and evolving technologies to measure tear stability, composition and meniscus height and their role in dry eye diagnosis and therapeutic efficacy grading is assessed.Evolving concepts regarding pathogenesis and new technologies to evaluate the tears and ocular surface have improved the ability to diagnose, classify and grade the severity of dry eye disease. New technologies include noninvasive imaging of tear stability and tear meniscus height as a measure of tear volume and tear composition (osmolarity, lacrimal factors, inflammatory mediators, growth and differentiation factors). Approved tests, such as tear osmolarity and tear imaging, are being integrated into clinical practice and may eventually supplant certain traditional tests that have greater variability and less sensitivity. Other tests, such as molecular assays of tears and conjunctival cells are currently being used in studies investigating pathogenesis and therapeutic mechanism of action. They may eventually translate to routine clinical practice.New technologies have emerged that can noninvasively evaluate the tears and measure disease-associated compositional changes. These tests are being integrated into clinical practice and therapeutic trials for diagnosis, classification and severity grading of dry eye disease.